Like teenagers with anorexia, teens with bulimia have great concern with weight and shape. There is a tendency to link a teen's body weight with self esteem.

Teenagers with bulimia regularly (at least twice a week) engage in overeating-even when not hungry. This is followed by guilt and anxiety and an attempt to remove the food from the body to avoid weight gain. Undoing the consequences of eating too much may involve self-induced vomiting, laxative use, diuretics (water pills), or enemas. Adolescents with bulimia may periodically skip meals, restrict food or engage in over exercising. In spite of this, most people with bulimia are of normal weight.

Many people with bulimia have other behavioral and mental health problems, such as impulsivity, depression, self-inflicted harm like cutting and burning, and substance abuse problems.

Over time, bulimic behaviors can result in physical problems. Some of these are swollen salivary glands, electrolyte and mineral imbalances, long lasting disruption of normal bowel function, erosion of the dental enamel, and rarely, tearing or rupturing of the esophagus or stomach or heart irregularities.

Bulimia is not generally seen in younger children and in general, has an older age of onset than anorexia (late teens and twenties). Similar to anorexia, recovery rates with treatment are about 50%, with an additional 30% who improve somewhat and about 20% who continue to have chronic symptoms of bulimia. Long-term follow-up studies, however, indicate that many people who suffer from chronic bulimic symptoms do eventually recover.

What is Bulimia Nervosa?

Bulimia nervosa is a serious eating disorder that can be fatal if left untreated. People who have bulimia nervosa routinely "binge," consuming large amounts of food in a very short period of time, and immediately "purge," ridding their bodies of the just-eaten food by self-inducing vomiting, taking enemas, or abusing laxatives or other medications. If left untreated, bulimia nervosa can lead to serious and even life-threatening problems, such as depression, anxiety disorders, heart damage, kidney damage, injury to all parts of the digestive system, and severe dental damage. Those with bulimia nervosa are at risk for dangerous impulsive, self-destructive behaviors, such as kleptomania, self-mutilation, alcohol and/or drug abuse, and sexual promiscuity.

Bulimia nervosa typically begins during adolescence, and while it most often occurs in women, it also affects men. Individuals with the disorder usually feel acutely out of control during both their bingeing and the purging episodes and afterwards suffer from intense feelings of shame, guilt and self-loathing. Embarrassed by their behavior, they typically "binge and purge" in secret and are often successful in hiding their problem from others. Even family members and close friends may have difficulty detecting bulimia nervosa in someone they know.

Symptoms

Obsessive preoccupation with food.

Excessive concern about body shape and weight.

Episodes of bingeing, consuming excessively large amounts of food in a short period of time (usually within two hours).

Episodes of purging to immediately get rid of just-consumed food using self-induced vomiting, taking enemas, or abusing laxatives or other medication.

Binge/purge behavior at least twice a week for a period of three months or longer.

Excessive exercise, often accompanying periods of fasting to counteract or prepare for binge episodes.

Disparaging self-criticism; depressed mood; feelings of shame and guilt during and after bingeing and purging episodes.

Although bingeing and purging usually occurs in secrecy or as inconspicuously as possible, the signs that a person has bulimia nervosa eventually become detectable. Warning signs include:

Abdominal pain and bloating.

Irregular menstrual cycle.

Constipation.

Swollen "chipmunk cheeks."

Dental erosion and decay.

Overall weakness.

Swelling (edema).

Swollen salivary glands.

Calluses and scabs on the back of the hand from constantly scraping them against their teeth while inducing vomiting.

Causes

While an exact cause or causes are yet unknown, bulimia nervosa is likely brought on by a complex interplay of factors which can include emotional and personality disorders, family stress, possible genetic or biologic susceptibilities, and a culture that is obsessed with body image and thinness.

Treatment

The first course of action should be to seek help from a physician to diagnose and treat any physical problems. To treat the symptoms of bulimia nervosa, people often benefit significantly from therapy. There are therapists who are especially experienced at helping people who have eating disorders. Therapy provides a safe, comforting, and confidential setting in which to receive the kind of help that can best determine and treat any underlying emotional and psychological causes for the disturbed eating. behavior, as well as address the effect it has had on their sense of self, their relationships with others, and their capacity to function optimally in everyday life.

New Research

Researchers have found that women with a history of bulimia show key differences in their brain's regulation of a hormone that controls mood and appetite, possibly suggesting an inherent susceptibility to the eating disorder.

"These alterations may make some women vulnerable for developing an eating disorder," lead author Dr. Walter H. Kaye, of the University of Pittsburgh School of Medicine in Pennsylvania, told Reuters Health.

Kaye's team studied nine women who have recovered from bulimia for at least one year. Bulimia nervosa is an eating disorder in which patients alternate between binge eating and purging. They suffer from a distorted body image and, often, mood disturbances such as depression.

All the women were scanned using positron emission tomography, or a (PET) scan, to gather images of brain activity. These were compared with brain scans from 12 women who had never had an eating disorder.

The researchers found that the bulimic patients' brains showed a reduction in the ability of the chemical serotonin to bind to receptors in certain brain regions. They also found that these women did not show the normal decline in serotonin binding that comes with aging.

Serotonin is a neurotransmitter that helps regulate appetite, mood and impulse control. The findings are published in the July issue of the American Journal of Psychiatry.

"I suspect this finding suggests that there is a dysregulation of the serotonin system, which contributes to extremes of impulse control--under eating as well as overeating--both of which are often found in bulimia," Kaye said.

He and his colleagues suspect the brain alterations were not a result of the bulimia, but a possible cause.

"While this finding could be a consequence of having bulimia, there is other data that suggests that certain traits, such as anxiety, may occur in childhood in people who later develop bulimia," Kaye said. "Serotonin alterations could contribute to such traits."

Previous research, he noted, has also found some evidence that bulimia has a genetic component.

Bulimia nervosa is a newer disorder than anorexia. In the 1980's and 1990's there was a dramatic rise in the number of cases, but now the number of new cases is stabilizing, with the largest proportion of people presenting for treatment being adolescents.